Dramatic drop seen in admissions for pneumonia, rotavirus

by Michael Smith Michael Smith North American Correspondent, MedPage Today
September 21, 2015

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Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

Childhood vaccines affect individual disease risk, but they also can have a dramatic impact on the use of healthcare.

Note that the use of pneumococcal and rotavirus vaccines led to reduction in admissions for pneumonia and for rotavirus that was paralleled by declines in outpatient visits to the emergency room for those causes, and an overall drop in admissions and ER visits.

SAN DIEGO -- Childhood vaccines affect individual disease risk, but they also can have a dramatic impact on the use of healthcare, a researcher said here.

And if one vaccine is good, two can be even better, argued Ron Dagan, MD, of Israel's Ben-Gurion University.

The impact was also felt in outpatient departments of Soroka University Medical Center in Beer-Sheba, which is the only hospital in the region and serves a population of about 30,000 children under two annually, Dagan said.

The bottom line, he told MedPage Today, is that "hospitalization and emergency room visits are the tip of the iceberg." If those encounters with the healthcare system are reduced, it implies a much greater drop in office visits to practicing physicians, he said.

The pneumococcus and rotavirus vaccines were introduced about the same time in Israel, he said, and were quickly accepted, with at least 90% of children 12 through 23 months having at least two doses within about a year of their respective introductions.

Since only a single hospital serves their region, Dagan and colleagues were able to track the vaccines' combined impact on healthcare.

They counted cases of alveolar pneumonia, lower respiratory tract infections other than pneumonia, rotavirus gastroenteritis, and non-rotavirus gastroenteritis from April 2006 through March 2014, finding totals of 4,383, 1,9525, 3,093, and 10,590 respectively among children under two.

Of the overall cases, 51.8% were admitted to hospital and 48.2% were treated in the emergency room.

Over the study period, hospital admissions attributed to pathogens not targeted by the vaccines remained roughly steady -- of all admissions every winter, about 30% were for non-alveolar pneumonia and lower respiratory infections and about 8% were for non-rotavirus gastroenteritis.

But the proportion of admissions for alveolar pneumonia fell from about 11% every winter to 7.5%, while admissions for rotavirus fell from about 8% to 1.3%, he reported. Put another way, the vaccines led to reduction in admissions of 46% for alveolar pneumonia and 78% for rotavirus, he said.

The drop in admissions was paralleled by declines in outpatient visits to the emergency room for those causes, but also by an overall drop in admissions and ER visits. It's likely, Dagan told MedPage Today, that primary care physicians also noticed quieter winter seasons, although that was not directly measured.

Such an effect is something would be expected if the results of clinical trials of vaccines were extrapolated to the community, commented Robin Patel, MD, of the Mayo Clinic in Rochester, Minn., a member of the conference program committee who was not involved in the study.

But, she told MedPage Today, it's important to follow up on clinical trial reports of vaccine efficacy to make sure that individual benefits do translate into a public health impact.

"You don't know for sure until you put the vaccine into play," she said.

But, she added, previous experience with childhood vaccines gives scientists confidence they will reduce the burden of disease on a wide scale. She recalled seeing as a medical student young patients with pneumonia caused by Haemophilus influenzae -- something her own students do not see, thanks to the vaccine against it.

One aspect that wasn't measured is the effect on adults of vaccinating children, commented Stephen Jenkins, PhD, of Weill Cornell Medical College in New York City, another member of the conference program committee who was not involved in the study.

"If you immunize the children that tend to have high rates of infection, you don't have transmission to the older adults who are also susceptible," Jenkins told MedPage Today.

This so-called herd immunity would also apply to rotavirus, in which even unvaccinated children would get some protection, because less of the disease would be circulating, he said.

But the reduction of disease would be expected to have a broader ripple effect on primary care physicians, whose waiting rooms would simply be less busy, he said. "Right now when we go to the physician we feel like they're rushed," he said. "If they can spend more time it's going to aid them and their diagnosis."

The authors did not report any external support for the study. Dagan disclosed financial links with Genocea, MeMed, MSD, GSK, and Pfizer.

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